Podiatrist, Dennis Rehbock, shares winter foot care advice for people living with diabetes.
While winter in South Africa may not be extremely cold and snowy like other places in the world, it can be unpleasant and pose some dangers to the feet of a person living with diabetes.
Foot care is of great importance to a diabetic patient and should be practiced every day. But, in winter it’s even more important if the patient is high risk, such as poor circulation, Raynaud’s disease (a condition in which some areas of the body feel numb and cool in certain circumstances), peripheral neuropathy (weakness, numbness and pain from nerve damage, usually in the hands and feet), or any foot ulceration.
Winter foot care tips
- Check your feet every day. Do this yourself if you can or get a family member or helper to do it. This will enable you to see any problems before they happen.
- Inspect for any lesions, discolouration, swelling, dryness, corns, cracked heels, peeling skin (especially in between toes), pain and numbness. Anything new or unusual should be seen to as soon as possible.
Even in this COVID-19 lockdown period you may and should go to your podiatrist or diabetic doctor for any problem or foot problem that you are having.
Keep your feet dry and warm
- Wash your feet daily. Dry them very well, especially in between the toes. Be gentle.
- If necessary, use foot powder on them before you put your socks and shoes on.
- If you have very dry feet then moisturise them daily after your bath or shower.
- Use an urea-based cream that is especially for dry feet. There are many on the market these days.
- Do not cream in between your toes. Rather keep that area dry.
- Any socks that are worn should be soft, warm, comfortable and should not have seams in them that could damage your skin. You do get special socks for diabetic feet to protect them.
- The sock material should be a moisture-wicking material to keep the feet dry. Cotton, wool and merino wool is good for this purpose.
- Modern sports and running socks are also made from materials like Drynamix and merino wool (see Falke and Balega socks).
- Some sock materials are infused with silver and copper to help with bacteria.
- Change your socks daily.
CAUTION: If you have cracked wet itchy skin in between your toes, go and see your podiatrist. It may be a fungus (Athlete’s foot) that needs treatment.
- In winter, it is best to wear closed shoes that will keep your feet warm and protected. They must keep your feet comfortably warm to help prevent chilblains, ulceration and Reynaud’s.
- The shoes should fit well and not cause any pressure or friction. They must also have good traction to help prevent slipping and falling.
- When you are around at home it is okay to wear thick soft warm sheepskin slippers.
CAUTION: Please do not heat your feet up in front of a fire, or a heater, or in any hot bath or footbath. Electric blankets must be used with extreme care.
Dry skin and hard skin
- If you have dry skin on your feet, moisturise them as mentioned.
- If you have hard skin, like corn, blisters and callouses, refrain from any self-treatment. Do not cut them yourself or use any acid-based creams on them. This is dangerous if you have poor peripheral circulation or peripheral neuropathy.
- Go and see your podiatrist for professional treatment of these lesions.
CAUTION: Do not cut these lesions yourself.
- If you can reach your nails and see them well then you may carefully cut your own nails. Cut straight across and file them to make them smooth.
- If you cannot reach or see them well then please do not cut them yourself. Go and see your podiatrist for regular foot care and they will cut your nails.
- Other nail pathologies also need treatment. Damaged nails, ingrown nails, fungal nails can also be treated.
Peripheral nerve changes
- Nerve changes in the feet can occur in patients living with diabetes. If your feet go numb (peripheral neuropathy), it can be a bad thing.
- Nerve changes can affect your ability to balance, to feel pain and foot damage. Your ability to feel heat could also be affected and this may cause foot damage without you knowing.
- Check the temperature of your bath before you get into it.
- Do not sit in front of a heater or fire to warm your feet. You could burn them.
- Keep your blood glucose levels well-controlled. Monitor your diet, exercise regularly, and avoid smoking.
- Have your feet screened once or twice a year for neural and vascular changes.
- The peripheral circulation is often affected in people living with diabetes. This can lead to minor vascular lesions in the feet, like chilblains, and to more serious lesions, like ulceration.
- Chilblains are a typical lesion that can occur in very cold weather, especially with sudden changes of temperature. If your circulation is also poor then you are at great risk of getting them.
- The lesions present as red/blueish patches on the skin of the feet and toes. This can also occur on the hands or other exposed areas. The small blood vessels go into a spasm and are usually painful. They are usually self-limiting, but if necessary, they need treating.
- Keeping your feet gently warm, and not smoking is important as smoking is a factor in the cause of chilblains. There are rub-on-creams that may help.
- In more severe cases, oral medication may be necessary to improve the peripheral circulation.
- Exercise also helps improve the peripheral circulation.
- It’s been observed that COVID-19 positive patients may have chilblain-like symptoms on the feet. Painful lesions that look very much like chilblains can appear in these patients, so care must be takes in the diagnosis of the chilblains.
- Go and see your podiatrist regularly (once or twice a year) or if you have any sudden foot problems in winter.
- Do not treat your own feet. Look after them, observe them daily, but go for professional treatment when necessary.
- Be very careful of using any unusual, untested products on your feet. Rather get professional advice.
- Urea-based foot creams or heel balms are good to use for dry feet.
- If you see any signs of infection or ulceration on your feet, go immediately to your foot care professional.
- Smoking is bad for your peripheral circulation.
- Exercise is good for your peripheral circulation. Get moving and go and walk or run.
MEET THE EXPERT
Dennis Rehbock is a podiatrist in private practice in Johannesburg. He has been a part-time lecturer and clinician at the University of Johannesburg Podiatry Department for 37 years. His special interest includes podiatric sports podiatry and the diabetic foot.
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